‘Kind of Awkward’: Doctors Find Themselves on a First-Name Basis
Dr. Yul Yang, a dermatologist at the Mayo Clinic in Scottsdale, Ariz., addresses all of his patients with an honorific — Mr. or Mrs. or Ms. — even if they ask him to use their first names. It is a sign of respect and a way of distinguishing his professional role as a doctor from a more personal role as a friend or confidant. But many patients do not reciprocate, calling him Yul instead of Dr. Yang.
He finds that “kind of awkward,” he said, though he lets it pass. But Dr. Yang and his colleagues began to wonder: How often do patients call doctors by their first names?
It wasn’t easy to answer this question, but Dr. Yang and his co-authors found a way — by studying tens of thousands of emails that patients sent to doctors at his institution. The results, published last week in the journal JAMA Network Open, appeared to illustrate a few themes about which doctors find themselves on a first-name basis with the people they care for.
Female doctors were more than twice as likely as male doctors to be addressed by their first names, as were doctors of osteopathy when compared with doctors with an M.D. behind their name.
Men were more likely than women to address doctors by their first name. Patients were more likely to address general practitioners by their first names than specialists.
The study found no difference based on age, whether of patient or physician. And the researchers did not examine the race or ethnicity of the patients or doctors.
The results, wrote Dr. Lekshmi Santhosh and Dr. Leah Witt of the University of California, San Francisco, in a commentary that accompanied the study, show “a subtle but important form of unconscious bias” against female physicians, general practitioners and doctors of osteopathy.
“Use of formal titles in medicine and many other professions is a linguistic signal of respect and professionalism,” they added.
Studying this issue, which they refer to as “untitling,” poses a number of challenges. At the Mayo Clinic, at least, “doctors don’t talk about it,” Dr. Yang said. And putting an observer in an exam room would create the medical version of the uncertainty principle: “Once an observer is in there everyone’s behavior will subtly change,” he said.
And there is little research to address the issue head on. A previous study, published in 2000, surveyed doctors and found that three quarters of them said some patients addressed them by their first name. But little else was available in the medical literature, and looking at emails offered a novel approach. The medical center supplied Dr. Yang and his colleagues with a trove of email exchanges, allowing analysis of 29,498 messages from 14,958 patients sent from Oct. 1, 2018, to Sept. 30, 2021.
The changing behavior they saw in the emails differs from even the recent past when it was all but unheard-of to call doctors by their first names, notes Jonathan Moreno, a professor of history and sociology of science at the University of Pennsylvania. He saw it in his own family, he added.